Association of mRNA Vaccination With Clinical and Virologic Features of COVID-19 Among US Essential and Frontline Workers
Authors: Gregory Joseph, John Barnes, Eduardo Azziz-Baumgartner, Melissa Arvay, Alicia Fry, Aron Hall, Preeta Kutty, Adam MacNeil, L. Clifford Donald, Sue Reynolds, Stephan Schrag, Nong Shang, Robert Slaughter, Natalie Thornburg, Jennife Verani, Rose Wang, Danielle R. Hunt, Brian Sokol, Robin Bloodworth, Claire Douglas, Isaiah Gerber, Louise Hadden, Jenna Harder, Nancy McGarry, Steve Pickett, Brandon P. Poe, Meghan Shea, John Thacker, Pearl Zheng, Peenaz Mistry, Kelly Patlan, Jessica Flores, Jazmin Duque, Laura J. Edwards, Jini Etolue, Lindsay LeClair, Khaila Prather, Michael E. Smith, Kempapura Murthy, Nicole Calhoun, Eric Hoffman, Martha Zayed, Joel Blais, Jason Ettlinger, Natalie Settele, Rupande Patel, Elisa Priest, Jennifer Thomas, Muralidhar Jatla, Madhava Beeram, Alejandro Arroliga, Yolanda Prado, Daniel S. Sapp, Mi Lee, Matt Hornbrook, Kristin Bialobok, Jennifer Alaspa, Daniel Stafki, Mary Robinson, Jill Dolezilek, Leia Hoffman, Tyna Connor, Catherine Luzio, Samantha Kendrick, Hannah Cowling, Olivia Healy, Gavin Tovar, Meccah Jarrah, Assumpta Nsengiyunva, Alison Slocum, Lili Steffen, Saskia Smidt, Alissa Coleman, Carly Deal, Hanna Hanson, Italia Trejo, Jeremy Makar, Sofia Grijalva, Krystal Jovel, Priyanka Sharma, Xiaoxiao Sun, Janko  Nikolich-Žugich, Joe K. Gerald, Juli Fisher, Karl Krupp, Lynn Gerald, Sally Littau, Ferris Ramadan, Erin Woods, Flavia Miiro, Gayatri Arani, Nicholas Tang, Nora Baccam, Ashley Lowe, Amelia Lobos, April Yingst, Danielle Stea, Natalya Mayhew, Raul Nava, Cynthia Porter, Andrea Carmona, Ariyah strong, Ashlyn Flangos, Caroline Klinck , Celia Pikowski, Chloe Hendrix, Cielo Perez, Cierra Morris, Erika Goebert, Gianna Taylor, Jayla Sowell, Jen Scott, Joe Mirabito, Jordan Baker, Kaitlyn Naff, Karysa Carson, Kennedy Obrien, Kiara Earley, Kristisha Mevises, Mayra Martinez, Mya Pena, Raven Hilyard, Rezwana Islam, Riley Perlman, Sarah Murray, Shelby Capell, Sienna Bigler, Ta’Nya Thomas, Tatum Butcher, Taylor Graham, Christian Rojas, John Jones, Brandon Astor, Ian A. Lee, Meghal S. Desai, Victoria Gomez, Rachael Reyes, Damena Gallimore-Wilson, Roger Noriega, Annabel Reyes, Brigitte Madan, Alexandra Cruz, Olga Carrera, Nathaly Suarez, Paola Feliciano, Johanna Garibaldi, Aimee Green, Addison Testoff, Rachel T. Brown, Camie Schaefer, Arlyne Arteaga, Matthew Bruner, Daniel Dawson, Emilee Eden, Jenna Praggastis, Joseph Stanford, Jeanma Mayer, Marcus Stucki, Riley Campbell, Kathy Tran, Madele Smith, Braydon Black, Christina Pick, Madison Tallman, Chapman Cox, Derrick Wong, Michael Langston, Adriel Fugal, Fiona Tsang, Maya Wheeler, Gretchen Maughan, Megan Wilson, Pasha Stinson, Jesse Williams, Taryn Smith, Seon Reed, Jinyi Mao, Nikki allacher, Kendal Chatard, Jenna Vo, Katie Luong, Ryder Jordin, Grace Stewart, Brock Bourdelle, Timina Powaukee, Max Minoughan, Hannah Whiting, Anika Souza, Ian Arlington, Lauren Anderson, Trevor Stubbs, Katherine Park, Talesha Jones, Mark G. Thompson, Sarang K. Yoon, Allison L. Naleway, Jennifer Meece, Thomas P. Fabrizio, Alberto J. Caban-Martinez, Jefferey L. Burgess, Manjusha Gaglani, Lauren E.W. Olsho, Allen Bateman, Jessica Lundgren, Lauren Grant, Andrew L. Phillips, Holly C. Groom, Elisha Stefanski, Natasha Schaefer Solle, Katherine Ellingson, Karen Lutrick, Kayan Dunnigan, Meredith G. Wesley, Kyley Guenther, Angela Hunt, Josephine Mak, Kurt T. Hegmann, Jennifer L. Kuntz, Adam Bissonnette, James Hollister, Spencer Rose, Tyler C. Morrill, Karley Respet, Ashley L. Fowlkes, Matthew S. Thiese, Patrick Rivers, Meghan K. Herring, Marilyn J. Odean, Young M. Yoo, Matthew Brunner, Edward J. Bedrick, Deanna E. Fleary, John T. Jones, Jenna Praggastis, James Romine, Monica Dickerson, Sana M. Khan, Julie Mayo Lamberte, Shawn Beitel, Richard J. Webby, Harmony L. Tyner
Journal: JAMA (2022)

Importance Data on the epidemiology of mild to moderately severe COVID-19 are needed to inform public health guidance. Objective To evaluate associations between 2 or 3 doses of mRNA COVID-19 vaccine and attenuation of symptoms and viral RNA load across SARS-CoV-2 viral lineages. Design, Setting, and Participants A prospective cohort study of essential and frontline workers in Arizona, Florida, Minnesota, Oregon, Texas, and Utah with COVID-19 infection confirmed by reverse transcriptase–polymerase chain reaction testing and lineage classified by whole genome sequencing of specimens self-collected weekly and at COVID-19 illness symptom onset. This analysis was conducted among 1199 participants with SARS-CoV-2 from December 14, 2020, to April 19, 2022, with follow-up until May 9, 2022, reported. Exposures SARS-CoV-2 lineage (origin strain, Delta variant, Omicron variant) and COVID-19 vaccination status. Main Outcomes and Measures Clinical outcomes included presence of symptoms, specific symptoms (including fever or chills), illness duration, and medical care seeking. Virologic outcomes included viral load by quantitative reverse transcriptase–polymerase chain reaction testing along with viral viability. Results Among 1199 participants with COVID-19 infection (714 [59.5%] women; median age, 41 years), 14.0% were infected with the origin strain, 24.0% with the Delta variant, and 62.0% with the Omicron variant. Participants vaccinated with the second vaccine dose 14 to 149 days before Delta infection were significantly less likely to be symptomatic compared with unvaccinated participants (21/27 [77.8%] vs 74/77 [96.1%]; OR, 0.13 [95% CI, 0-0.6]) and, when symptomatic, those vaccinated with the third dose 7 to 149 days before infection were significantly less likely to report fever or chills (5/13 [38.5%] vs 62/73 [84.9%]; OR, 0.07 [95% CI, 0.0-0.3]) and reported significantly fewer days of symptoms (10.2 vs 16.4; difference, −6.1 [95% CI, −11.8 to −0.4] days). Among those with Omicron infection, the risk of symptomatic infection did not differ significantly for the 2-dose vaccination status vs unvaccinated status and was significantly higher for the 3-dose recipients vs those who were unvaccinated (327/370 [88.4%] vs 85/107 [79.4%]; OR, 2.0 [95% CI, 1.1-3.5]). Among symptomatic Omicron infections, those vaccinated with the third dose 7 to 149 days before infection compared with those who were unvaccinated were significantly less likely to report fever or chills (160/311 [51.5%] vs 64/81 [79.0%]; OR, 0.25 [95% CI, 0.1-0.5]) or seek medical care (45/308 [14.6%] vs 20/81 [24.7%]; OR, 0.45 [95% CI, 0.2-0.9]). Participants with Delta and Omicron infections who received the second dose 14 to 149 days before infection had a significantly lower mean viral load compared with unvaccinated participants (3 vs 4.1 log 10 copies/μL; difference, −1.0 [95% CI, −1.7 to −0.2] for Delta and 2.8 vs 3.5 log 10 copies/μL, difference, −1.0 [95% CI, −1.7 to −0.3] for Omicron). Conclusions and Relevance In a cohort of US essential and frontline workers with SARS-CoV-2 infections, recent vaccination with 2 or 3 mRNA vaccine doses less than 150 days before infection with Delta or Omicron variants, compared with being unvaccinated, was associated with attenuated symptoms, duration of illness, medical care seeking, or viral load for some comparisons, although the precision and statistical significance of specific estimates varied.